Notice of Privacy Practices

Individually identifiable information about your past, present, or future health or
condition, the provision of health care to you, or payment for the health care is
considered “Protected Health Information” (PHI). University Health Services is required
to extend certain protections to your PHI, and to give you this Notice about our privacy
practices that explains how, when and why we may use or disclose your PHI. Except
in specified circumstances, we must use or disclose only minimum necessary PHI in
a limited data set as defined by regulations to accomplish the intended purpose of
the use or disclosure.

We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice
at any time. You may request a copy of the new notice from University Health Services or the
Compliance Office 1202 Farm Road, Stillwater, OK 74078.

Our Responsibilities Regarding Your Protected Health Information

How We May Use and Disclose Your Protected Health Information

We use and disclose PHI for a variety of reasons. We have a limited right to use
and/or disclosure of your PHI for purposes of treatment, payment or our health care
operations. For uses beyond that, we must have your written authorization unless
the law permits or requires us to make the use or disclosure without your authorization.
If we disclose your PHI to an outside entity in order for that entity to perform a
function on our behalf, we must have in place an agreement from the outside entity
that it will extend the same degree of privacy protection to your information that
we must apply to your PHI. However, the law provides that we are permitted to make
some uses/disclosures without your consent or authorization.

It is the policy of University Health Services to not use PHI for marketing purposes,
nor will any PHI be sold. In the event University Health Services were to contact
you regarding fundraising, that communication shall include the option to opt out
of future communications. Oklahoma law requires that we inform you that the information used or disclosed may include records which indicate the presence of
a communicable or venereal disease which may include, but are not limited to, hepatitis,
syphilis, gonorrhea, Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency
Syndrome (AIDS). Any use or disclosure also may include mental health or other sensitive
information. The following offers descriptions and some examples of our potential uses/disclosures
of your PHI.

For treatment: We may disclose your PHI to doctors, nurses, and other health care personnel who
are involved in providing your health care. For example, your PHI will be shared
among members of your treatment team and other UHS staff. Your PHI may also be shared
with outside entities performing ancillary services relating to your treatment, such
as for interpretation of x-rays, or for consultation purposes in provision or coordination
of your care.

To obtain payment: We may use/disclose your PHI in order to bill and collect payment for your health
care services. For example, we may contact and/or release portions of your PHI to
a private insurer to get paid for services that we delivered to you. We may release
information to third parties for collection purposes. Any charges not paid at time
of service will be transferred to the OSU Bursar.

For health care operations: We may use/disclose your PHI in the course of operating our clinic. For example,
we may disclose your PHI to our accountant or attorney for audit purposes. We may
disclose your PHI to designated staff in our facility or offices for similar purposes.

Appointment reminders: Unless you provide us with alternative instructions, we may send appointment reminders
and other similar materials to your home, or notify you of appointments by phone.

Uses and Disclosures Requiring Authorization

For uses and disclosures beyond treatment, payment and operations purposes we are
required to have your written authorization, unless the use or disclosure falls within
one of the exceptions described below. Disclosures of any psychotherapy notes, disclosures
that include the sale of PHI or disclosures for marketing purposes require your authorization.
Authorizations can be revoked at any time to stop future uses/disclosures except to
the extent that we have already undertaken an action in reliance upon your authorization.
In addition, any other uses and disclosures not described in this notice shall be
made with only your authorization.

Uses and Disclosures of PHI not requiring consent or authorization

The law provides that we may use/disclose your PHI without consent or authorization
in the following circumstances:

When required by law: We may disclose PHI when a law requires that we report information about suspected
abuse, neglect or domestic violence, or relating to suspected criminal activity, or
in response to a court order. We must also disclose PHI to authorities that monitor
compliance with these privacy requirements.

For public health activities: We may disclose PHI when we are required to collect information about disease or
injury, or to report vital statistics to the public health authority.

For health oversight activities: We may disclose PHI to our central office, or another agency responsible for monitoring
the health care system for such purposes as reporting or investigation of unusual
incidents.

Relating to decedents: We may disclose PHI relating to an individual’s death to coroners, medical examiners
or funeral directors, and to organ procurement organizations relating to organ, eye,
or tissue donations or transplants.

For research purposes: In certain circumstances, and under supervision of a privacy board, we may disclose
PHI to our research staff and their designees in order to assist medical/psychiatric
research.

To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary
to law enforcement or other persons who can reasonably prevent or lessen the threat
of harm.

For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to
correctional facilities in certain situations, to government benefit programs relating
to eligibility and enrollment, and for national security reasons, such as protection
of the President.

For Worker’s Compensation purposes: We may disclose PHI in relation to workers’ compensation programs, established by
law, that provide benefits for work-related injuries or illnesses.

Uses and Disclosures of PHI from Alcohol and Other Drug Records Not Requiring Consent
or Authorization

The law provides that we may use/disclose your PHI from alcohol and other drug records
without consent or authorization in the following circumstances:

When required by law: We may use/disclose PHI when a law requires that we report information about suspected
child abuse and neglect, or when a crime has been committed on the premises or against
personnel, or in response to a court order.

Relating to decedents: We may disclose PHI relating to an individual’s death if state or federal law requires
the information for collection of vital statistics or inquiry into cause of death.

For research, audit or evaluation purposes: In certain circumstances, we may disclose PHI for research, audit or evaluation
purposes.

To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary
to law enforcement when a threat is made to commit a crime on the premises or against
personnel.

Uses and Disclosures Requiring You to have an Opportunity to Object

In the following situations, we may disclose a limited amount of your PHI if we inform
you about the disclosure in advance and you do not object, as long as the disclosure
is not otherwise prohibited by law.

Patient Directories: Your name, location, and general condition may be disclosed to callers or visitors
who ask for you by name. Additionally, your religious affiliation may be shared with
clergy.

To families, friends or others involved in your care: We may share with these people information directly related to their involvement in
your care, or payment for your care. We may also share PHI with these people to notify
them about your location, general condition, or death.

Your Rights Regarding Your Protected Health Information

You have the following rights relating to your protected health information:

To request restrictions on uses/disclosures: You have the right to ask that we limit how we use or disclose your PHI. We will
consider your request, but are not legally bound to agree to the restriction. To
the extent that we do agree to any restrictions on our use/disclosure of your PHI,
we will put the agreement in writing and abide by it except in emergency situations.
We cannot agree to limit uses/disclosures that are required by law. An individual
paying the full cost of the care provided may request that PHI of that visit not be
disclosed, however such a restriction of use of PHI cannot be accommodated if the
individual is requesting UHS use the PHI to obtain payment for services. Only in
the case of an individual paying full cost at time of service can make this request.
This request is limited to use of PHI for payment or health care operations. This
request cannot limit use of PHI for treatment purposes.

To choose how we contact you: You have the right to ask that we send your information to an alternative address
or by an alternative means. We must agree to your request as long as it is reasonably
easy for us to do so.

To inspect and request a copy of your PHI: Unless your access to your records is restricted for clear and documented treatment
reasons, you have a right to see your protected health information upon your written
request. We will respond to your request within 30 days. If we deny your access,
we will give you written reasons for the denial and explain any right to have the
denial reviewed. If you want copies of your PHI, a charge for copying may be imposed,
depending on your circumstances. You have a right to choose what portions of your
information you want copied and to have prior information on the cost of copying.
You have a right to electronic copies of electronic health records maintained by UHS
or a designated third party. This right is limited to your health related records,
and if requested will be required to pay the labor costs associated with such request.

To request amendment of your PHI: If you believe that there is a mistake or missing information in our record of your
PHI, you may request, in writing, that we correct or add to the record. We will respond
within 60 days of receiving your request. We may deny the request if we determine
that the PHI is (i) correct and complete; (ii) not created by us and/or not part of
our records, or; (iii) not permitted to be disclosed. Any denial will state the reasons
for denial and explain your rights to have the request and denial, along with any
statement in response that your provide, appended to your PHI. If we approve the
request for amendment, we will change the PHI and so inform you, and tell others that
need to know about the change in PHI.

To find out what disclosures have been made: You have a right to get a list of when, to whom, for what purpose, and what content
of your PHI has been released other than instances of disclosure for treatment, payment,
and operations; to you, your family, or the facility directory; or pursuant to your
written authorization. The list also will not include any disclosures made for national
security purposes, to law enforcement officials or correctional facilities, or disclosures
made before April 14, 2003. We will respond to your written request for such a list
within 60 days of receiving it. Your request can relate to disclosures going as far
back as six years. There will be no charge for up to one such list each year. There
may be a charge for more frequent requests.

To receive this notice

You have a right to receive a paper copy of this Notice and/or an electronic copy
by email upon request.

How to Complain about our Privacy Practices

If you have questions about this Notice or any complaints about our privacy practices,
please contact the Compliance Office listed below. If you think we may have violated
your privacy rights, or you disagree with a decision we made about access to your
PHI, you may request information or file a complaint by contacting: